Clinical Characteristics of Complex Partial Seizures: a Temporal versus a Frontal Lobe Onset

ABSTRACT

PURPOSE: This study was performed to correlate clinical behaviours with either a temporal or frontal site of origin and then to identify behaviours that might have a significant practical value in differentiating a temporal from a frontal focus and thus reduce the need for invasive monitoring. METHODS: We analysed 129 seizures that occured during video-EEG monitoring in 13 patients with temporal lobe epilepsy (TLE) and in 9 patients with frontal lobe epilepsy (FLE) as well as neuroimaging studies. We compared first the clinical behaviours that occurred in frontal lobe seizures to those of temporal lobe seizures (second stage analysis). To eliminate clinical behaviours that could occur as the discharge propagated another lobe, we compared only clinical seizure events in which we had no evidence of spread to other regions, or that spread only to the homologous contralateral lobe (first stage analysis). The Fisher exact test was used for analysis. RESULTS: Although staring, sitting up, leg movement, and tonic-clonic movement, generalization occurred more frequently in FLE, and oral, alimentary and hand automatisms were more frequent in TLE, no statistically significant difference was found between the two groups. In second stage analysis, sitting up, tonic-clonic movement were seen only in FLE and oral, alimentary and hand automatisms only in TLE. Staring, hand posturing occurred more frequently in FLE. CONCLUSION: We therefore conclude that the reliability of clinical behaviour alone to predict the site of origin of an epileptic discharge is limited when the surface EEG is equivocal or neuroradiologic evidence of a focus is not clear.